Zosteriform B-cell chronic lymphocytic leukemia infiltration

Cutaneous infiltration by leukemic cells is uncommon and may be associated with progression of disease. The authors present the case of a 77-year-old female patient, referred to the dermatology clinic for red, erythematous, pruritic papules, which had suddenly appeared on her left hemithorax, along the C6 dermatome, with a 4-week duration. She had already been medicated with Valacyclovir and Acyclovir for 4 weeks, without clinical improvement. She also had a diagnosis of B-cell chronic lymphocytic leukemia (B-CLL), type 2 diabetes mellitus, and multinodular goiter. Tzanck smear showed no multinucleated giant cells,and PCR testing for Varicella Zoster Virus (VZV) and Herpes Simplex Virus (HSV) on skin biopsy was negative. Histopathology showed a typical B-CLL infiltrate (CD3+, CD20+) and cytogetic analysis was compatible with alterations seen in the bone marrow, confirming the diagnosis of cutaneous infiltration by B-CLL. The patient began chemotherapy with chlorambucil and intravenous human immunoglobulin, which resulted in total regression of the lesions as well as the pruritus. Even though lymphocytic infiltration of Herpes Simplex or Herpes Zoster scars is well documented, cutaneous infiltration with a zosteriform distribution without a previous episode of herpes is very rare. The therapeutic target should be the leukemia itself.